Think Big, Start Small, Act Now--Baltimore City Takes a New Look At Birth Outcomes and Safe Sleep—An Innovative, Multi-Level Approach

Background: In 2009, 27 babies died in Baltimore City because they were put to sleep in an unsafe environment. To address this issue, B’more for Healthy Babies, a coalition of organizations and agencies committed to reducing Baltimore’s high infant mortality rate, developed and implemented an innovative, multi-level approach that included a hard-hitting reality-based city-wide campaign, grass roots community-based and mid-media activities, and changes in citywide policies and service delivery procedures.

Program background: This presentation will outline the City’s new approach to safe sleep (SLEEP SAFE: Alone. Back. Crib. No exceptions.). The centerpiece of the initiative is a7 minute video featuring women who lost babies due to unsafe sleeping environments. Radio, TV, outdoor and print materials were developed from the video. We will discuss the theoretical framework used for the campaign (Extended Parallel Process Model), how we balanced fear and efficacy, the implementation of activities at the policy, service, community and individual levels, and the evaluation of the program. Initial findings show high penetration of messages, as well as correlations between message exposure and knowledge of safe sleep practices. We will also discuss the larger B’more for Healthy Babies initiative, which looks to reduce infant mortality in the City by focusing attention and action on 11 defined high impact health areas.

Evaluation Methods and Results: The campaign is being evaluation through a community-based telephone survey, clinic-based survey and vital statistics. Preliminary results of the community survey found about 39% of respondents recalled the campaign's messages and there were postive effects of correct TV message recall and poster message recall on safe sleep knowledge.

Conclusions: The reality, fear-based approach balanced with efficacy-related messages is an effective way to "break through" complacency about safe sleep practices and change behaviors if messages are presented repeatedly through different channels.

Implications for research and/or practice: This approach could be a model for other cities plagued by high infant mortality rates due to unsafe sleeping environments.